Fall Prevention in Aging: Does Gaze Stabilization Outperform Traditional Balance Training?

dR. ULKU KARABULUT KINE 6355

Fall Prevention in Aging: Does Gaze Stabilization Outperform Traditional Balance Training?

Claudia Rodriguez Hadar

06/10/18

What is a fall?

Event that results in a person coming to rest on the ground or other lower-level unintentionally, which is not as a result of a major intrinsic event (such as stroke) or overwhelming hazard.(1)

Etiology

The gait process is the result of the work of basal ganglia brainstem system (posture & balance), regulated muscle tone (strength) and functional processing of sensory information (vision, hearing, proprioception). (2)

Therefore these functions decline with aging.

Basal ganglia

Posture and balance (2)

Regulated muscle tone

Strength (2)

Processing

sensorial information

Vision, hearing, proprioception (2)

Reduced functionality

Morbidity

Mortality

Disability

Falls are commonly associated with (2)

Gait type in the elderly

Wide base gait

Decrease in velocity and length

Decreased lower limb strength

Epidemiology (2)

40%

30%

The most common type of accident on people over 65 years of age.

Of individuals who are over 65 years old fall every year.

The percentage increases up to 40% when the age is above 85.

10%

Of falls result in serious injuries.

What happens after a fall?

In the worst case scenario...

Traumatic brain injury (2)

Hip fracture (2)

Hipothermia (5)

Wrist fracture (5)

Subdural hematoma (2)

Dehidration (5)

But most of all...

Fear of falling

This fear can limit independence and daily life activities, as well as leading to loosing balance confidence and decreasing physical activity; this in return can result in falls, creating a vicious cycle. (6)

Two Types of Treatments Proposed

Gaze exercises

Balance training

Balance training includes both static and dynamic balance exercises, aimed to improved balance and postural stability with gradually increasing to challenging task. (7)

• Dyanmic
• Static

Habituation exercises which reduce the symptoms of provoking stimulus by continuous exposure to it; these exercises are helpful to prevent falls and fear of fall due to age related decline in vestibular system. (7) Adaptation: support long term changes with a purpose of decreasing symptoms and maintain postural stability. Substitution: improve central pre-programing movement of eyes.

1. Describe two characteristics of the gait pattern in the elderly and provide an example.

2. Give an example of a muscle involved in the gait process and explain how it is related to walking.

3. What is proprioception and how is it related to walking on an uneven surface?

4. Describe 2 severe injuries caused by falls in the elderly (as shown in the presentation) and provide another possible cause that you personally think it could occur.

5. What is the common age at which falls start to occur?

6.In your own words, describe the vicious cycle of the fear of falling (3 components)

Effects of balance training with and without gaze stabilization exercises on clinical outcomes in elderly patients with chronic dizziness: A randomized controlled trial (7) Syeda Nida Fatima et al

Introduction

In older adults dizziness is a common condition which is associated with repeated falls, fear of falling, depression, anxiety and ultimately loss of independence during activities of daily living (8) Dizziness is properly described as the sense of instability or minor intoxication, the affected person feels that ground is rocking or he has to maintain balance by taking side step. (9) According to previous studies (Vestibular rehabilitation for peripheral vestibular hypofunction, Hall et al) gaze stability exercises are beneficial among elderly population to improve balance and to treat age related dizziness. These exercises are helpful to prevent falls and fear of fall due to age related decline in vestibular system. (10)

Methods

Methods

Methods

Assignment

Assessment

Results

Interpretation

Extrapolation

Comparison of effects of Otago exercise program vs gaze stability exercise on balance and fear of fall in older adults: A randomized trial (11)

KP, Nimmi et al

Introduction

With progressive aging, older individuals are commonly subjected to reduced muscle mass, strength, bone density, abnormal breathing, a longer reaction time, degradation of the vestibular system with reduced visual VOR (vestibularocular reflex) and cognitive ability deterioration which results as decreased balance and an increased tendency to fall, this results in increased disability (11-13) Thus, the individual experiences diminished visual acuity during head motion and loss of balance, fear of falls and low balance confidence results in lesser autonomy, activity limitations. (14)

Introduction

The Otago Exercise Program (OEP) is a multimodal exercises program which was developed by Professor John Campbell at the University of Otago in Dunedin, New Zealand, encompassing all the components necessary to yield improvements in the balance, strength, and functional capacity of the elderly population. (15) Gaze stability exercises aim to foster vestibular adaptation to promote the recovery of vestibular response through the reciprocal interaction between the visual and vestibular systems during head movements. (16)

Methods

Methods

Methods

Assignment

Assessment

Results

Interpretation

Extrapolation

Main references

7. Fatima SN, Tanveer F, Shoukat F, Ahmad A, Siddique K. Effects of balance training with and without gaze stabilization exercises on clinical outcomes in elderly patients with chronic dizziness: A randomized controlled trial. J Bodyw Mov Ther [Internet]. 2022;32:46–50. Available from: http://dx.doi.org/10.1016/j.jbmt.2022.05.007 11. Kp N, D A, Nawed A, Nuhmani S, Khan M, Alghadir AH. Comparison of effects of Otago exercise program vs gaze stability exercise on balance and fear of fall in older adults: A randomized trial. Medicine (Baltimore) [Internet]. 2024;103(23):e38345. Available from: http://dx.doi.org/10.1097/MD.0000000000038345

References

1. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med [Internet]. 1988;319(26):1701–7. Available from: http://dx.doi.org/10.1056/NEJM198812293192604 2. Appeadu MK, Bordoni B. Falls and fall prevention in older adults. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025. 3. Reeves ND, Orlando G, Brown SJ. Sensory-motor mechanisms increasing falls risk in diabetic peripheral neuropathy. Medicina (Kaunas) [Internet]. 2021 [cited 2025 Mar 14];57(5):457. Available from: https://www.mdpi.com/1648-9144/57/5/457 4. Bakken MS, Engeland A, Engesæter LB, Ranhoff AH, Hunskaar S, Ruths S. Risk of hip fracture among older people using anxiolytic and hypnotic drugs: a nationwide prospective cohort study. Eur J Clin Pharmacol [Internet]. 2014;70(7):873–80. Available from: http://dx.doi.org/10.1007/s00228-014-1684-z 5. Instituto Nacional de las Personas Adultas Mayores. Manual para la prevención y atención de caídas en personas adultas mayores [Internet]. 2024. Available from: https://www.gob.mx/cms/uploads/attachment/file/929765/08_MANUAL_PARA_LA_PREVENCIO_N_Y_ATENCIO_N_DE_CAI_DAS_EN_PAMS_APA.pd

References

6. Aibar-Almazán A, Martínez-Amat A, Cruz-Díaz D, De la Torre-Cruz MJ, Jiménez-García JD, Zagalaz-Anula N, et al. Effects of Pilates on fall risk factors in community-dwelling elderly women: A randomized, controlled trial. EJSS (Champaign) [Internet]. 2019;19(10):1386–94. Available from: http://dx.doi.org/10.1080/17461391.2019.1595739 8. Geraghty AWA, Essery R, Kirby S, Stuart B, Turner D, Little P, et al. Internet-based vestibular rehabilitation for older adults with chronic dizziness: A randomized controlled trial in primary care. Ann Fam Med [Internet]. 2017;15(3):209–16. Available from: http://dx.doi.org/10.1370/afm.2070 9.Maciaszek J, Osinski W. Effect of Tai Chi on body balance: randomized controlled trial in elderly men with dizziness. Am J Chin Med [Internet]. 2012;40(2):245–53. Available from: http://dx.doi.org/10.1142/S0192415X1250019X 10.Hall CD, Herdman SJ, Whitney SL, Cass SP, Clendaniel RA, Fife TD, et al. Vestibular rehabilitation for peripheral vestibular hypofunction: An evidence-based clinical practice guideline: FROM THE AMERICAN PHYSICAL THERAPY ASSOCIATION NEUROLOGY SECTION. J Neurol Phys Ther [Internet]. 2016;40(2):124–55. Available from: http://dx.doi.org/10.1097/NPT.0000000000000120 12. Yang Y, Wang K, Liu H, Qu J, Wang Y, Chen P, et al. The impact of Otago exercise programme on the prevention of falls in older adult: A systematic review. Front Public Health [Internet]. 2022;10:953593. Available from: http://dx.doi.org/10.3389/fpubh.2022.953593

References

13. Arzhane SSD, Hazrati M, Ashraf A. The effect of Otago Exercise Program training on balance and fear of falling in elderly individuals [Internet]. Research Square. 2019. Available from: http://dx.doi.org/10.21203/rs.2.17067/v1 14.Bhardwaj V, Vats M. Effectiveness of gaze stability exercise on balance in healthy elderly population. Int J Physiother Res. 2014;2:642–7. 15. Kocic M, Stojanovic Z, Nikolic D, Lazovic M, Grbic R, Dimitrijevic L, et al. The effectiveness of group Otago exercise program on physical function in nursing home residents older than 65 years: A randomized controlled trial. Arch Gerontol Geriatr [Internet]. 2018;75:112–8. Available from: http://dx.doi.org/10.1016/j.archger.2017.12.001 16. Shelhamer M, Tiliket C, Roberts D, Kramer PD, Zee DS. Short-term vestibulo-ocular reflex adaptation in humans: II. Error signals. Exp Brain Res. 1994;100:328–36.

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